Individual
MICHELLE LAGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, CCC-SLP
Contact information
Practice address
1406 6TH AVE N, SAINT CLOUD, MN 56303-1901
(320) 251-2700
(320) 656-7115
Mailing address
1406 6TH AVE N, SAINT CLOUD, MN 56303-1901
(320) 251-2700
(320) 656-7115
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
5971
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41-0695596
—
MN
Enumeration date
04/04/2018
Last updated
04/04/2018
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